Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.
Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.
J Neuroeng Rehabil. 2022 Mar 17;19(1):28. doi: 10.1186/s12984-022-01009-3.
Most activities of daily life (ADL) require cooperative bimanual movements. A unilateral stroke may severely impair bimanual ADL. How patients with stroke (re)learn to coordinate their upper limbs (ULs) is largely unknown. The objectives are to determine whether patients with chronic supratentorial stroke could achieve bimanual motor skill learning (bim-MSkL) and to compare bim-MSkL between patients and healthy individuals (HIs).
Twenty-four patients and ten HIs trained over 3 consecutive days on an asymmetrical bimanual coordination task (CIRCUIT) implemented as a serious game in the REAplan® robot. With a common cursor controlled by coordinated movements of the ULs through robotic handles, they performed as many laps as possible (speed constraint) on the CIRCUIT while keeping the cursor within the track (accuracy constraint). The primary outcome was a bimanual speed/accuracy trade-off (biSAT), we used a bimanual coordination factor (biCO) and bimanual forces (biFOP) for the secondary outcomes. Several clinical scales were used to evaluate motor and cognitive functions.
Overall, the patients showed improvements on biSAT and biCO. Based on biSAT progression, the HI achieved a larger bim-MSkL than the patients with mild to moderate impairment (Fugl-Meyer Assessment Upper Extremity (FMA-UE): 28-55, n = 15) but not significantly different from those with minimal motor impairment (FMA-UE: 66, n = 9). There was a significant positive correlation between biSAT evolution and the FMA-UE and Stroke Impact Scale.
Both HI and patients with chronic stroke training on a robotic device achieved bim-MSkL, although the more impaired patients were less efficient. Bim-MSkL with REAplan® may be interesting for neurorehabilitation after stroke.
ClinicalTrial.gov identifier: NCT03974750. Registered 05 June 2019. https://clinicaltrials.gov/ct2/show/NCT03974750?cond=NCT03974750&draw=2&rank=1.
日常生活活动（ADL）的大多数活动都需要双手协作。单侧中风可能会严重影响双手 ADL。患者如何重新学习协调上肢（UL）还知之甚少。目的是确定慢性幕上卒中患者是否能够实现双手运动技能学习（bim-MSkL），并比较患者与健康个体（HIs）之间的 bim-MSkL。
24 名患者和 10 名 HIs 在 REAplan®机器人上的不对称双手协调任务（CIRCUIT）上进行了 3 天的连续训练，该任务作为一款严肃游戏实施。通过 UL 协调运动控制的共同光标通过机器人手柄，他们在 CIRCUIT 上尽可能多地完成圈数（速度限制），同时将光标保持在轨道内（精度限制）。主要结果是双手速度/精度权衡（biSAT），我们使用双手协调因子（biCO）和双手力（biFOP）作为次要结果。还使用了几种临床量表来评估运动和认知功能。
总体而言，患者在 biSAT 和 biCO 上均有所提高。根据 biSAT 的进展，HI 比轻度至中度运动障碍患者（Fugl-Meyer 上肢评估（FMA-UE）：28-55，n=15）实现了更大的 bim-MSkL，但与运动障碍最小的患者无明显差异（FMA-UE：66，n=9）。biSAT 进化与 FMA-UE 和中风影响量表之间存在显著正相关。
HI 和慢性中风患者都可以在机器人设备上进行 bim-MSkL 训练，尽管更严重的患者效率较低。使用 REAplan®进行 bim-MSkL 可能对中风后的神经康复很有意义。
ClinicalTrials.gov 标识符：NCT03974750。2019 年 6 月 5 日注册。https://clinicaltrials.gov/ct2/show/NCT03974750？cond=NCT03974750&draw=2&rank=1.
